MEDICARE: OUR HOUSE OF FAVOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1316726094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUR HOUSE OF FAVOR

Provider Business Mailing Address
First Line	:	135 SHADOW ROCK CT
Second Line	:
City	:	SHEPHERDSVILLE
State	:	KY
Zip	:	40165-4607
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1546 BERRY BLVD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40215-1955
Country	:	US
Telephone Number	:	502-912-2689
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SAYBAH GLAY
Credential	:
Telephone Number	:	502-689-2830

Provider Enumeration Date	:	09/22/2023
Last Update Date	:	11/16/2023

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Directions to “OUR HOUSE OF FAVOR ” Practice Location

Language	Start Address	Practice Location

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